Der Begriff der Evidenzbasierten Medizin ist in der Medizin klar definiert. Die Umdeutungsversuche von homöopathischer Seite haben keine Grundlage.
The interpretation of evidence-based medicine (EBM) by the representatives of homeopathy:: a narrative that has been cultivated for years and has grown in intensity. It is probably due to the ongoing effort to gain reputation in the scientific world. But it is undoubtedly not very promising to unilaterally redefine given criteria instead of fulfilling them. And this is precisely where the homeopathic scene has arrived in the meantime.
The German Central Association of Homeopathic Doctors (DZVhÄ) proclaims on its website (in German) “Thematic Service Research: Homeopathy is Evidence-Based Medicine”. Incidentally, this is promoted on Twitter by an account that presumptuously calls itself “Evidence Based Medicine”. The owner of this account is Dr Nancy Malik, Medical Doctor of Homeopathy, Super-Avogadro Clinic (sic!), Gurgaon (India, state of Harayana). The lady with the attention-grabbing name of her Twitter account certainly came across the German-language article of the DZVhÄ purely by chance and felt animated to promote it.
But that is ultimately beside the point. The main thing is the complete aberration of the article in a downright reversal of the real intention of the model of evidence-based medicine. Not only the title, but also the diagram at the beginning shows the fundamental error in all clarity and makes further reading almost superfluous:
This is not the first attempt to reinterpret the clearly defined concept of evidence-based medicine in the sense of homeopathy, as if it were possible and conceivable to “choose” which of the three “equal pillars” one could give preference to in the therapeutic decision. It is clear that this view opens the door to the preferences of homeopathically inclined therapists and patients. In a certain way, this is a kind of ” scientification” of the popularity argument. But it goes beyond promotional rhetoric in that it tries to negate the scientific consensus on EBM.
The claim that homeopathy meets the criteria of evidence-based medicine is apparently an increasingly important narrative for the homeopathic scene, with which it wants to justify its entitlement to “scientificity” and a place in the scientific environment. However:
The concept of EBM, with which the essay by Sackett et al. in 1997 gave the final impetus to the paradigm shift from purely empirical medicine to a consistently science-based medicine, is clearly and unambiguously defined. Evidence-based medicine is “the utilisation of the best available clinical evidence for concrete therapeutic decisions”. Physician expertise and legitimate patient concerns are accompanying and, if necessary, corrective factors, but neither sufficient nor always necessary for EBM.
The purpose of these aspects is to prevent EBM from becoming a “template medicine”, e.g. to give a different weighting to the therapy decision in individual cases where the clinical evidence does not seem to be indicated. The inclusion of these aspects also has a medical ethical background, since a patient’s preference can, for example, also consist in rejecting a certain form of therapy. However, to see this as an authorisation for “desired medicine” fails to meet the intentions of EBM.
Under no circumstances, however, does the definition of EBM open up a “choice” in the sense that preferences of therapists and/or patients outside of such special circumstances could “replace” or “displace” the foundation of a therapy decision on valid clinical evidence. This is exactly the aim of the DZVhÄ’s postulation of “three equal pillars” as the basis of EBM.
If this were the case, the establishment of evidence-based medicine would have been completely unnecessary – in other words, if the postulate of the “three equal pillars” were true, EbM would at the same time be robbed of its essence.
It seems to us to be an unpromising strategy to redefine the premises of EBM if one cannot fulfil them. It is justifiably doubtful whether any reputation in the scientific world can be achieved in this way. At the same time, it also becomes clear that and why the homeopathic community is apparently neither willing nor able to recognise the negative overall evidence of homeopathy – according to the real criteria of evidence-based medicine – which, as is well known, follows from the reviews and meta-analyses of the critically evaluated Body of Evidence.